Paper short abstract:

The overall aim of evidence-based medicine is to reduce uncertainty through the use of standardized methods for knowledge evaluation and use. We argue that uncertainties are possible sources to informed decision making and not a threat against evidence-based clinical reasoning.

Paper long abstract:

The evidence-based practice (EBP) and evidence-based medicine (EBM) movements have increased the focus on standardization through the development of new guideline development methodologies based on systematic reviews and meta-analysis of best available research. EBM has challenged clinicians to question their reliance on practical reasoning and clinical judgement.

In this paper we will argue that the overall aim of EBM is to reduce uncertainty through the use of standardized methods for knowledge evaluation and use. With this drive towards uniformity, standardization and control comes a suspicion towards intuition, creativity and uncertainty as integral parts of medical practice.

We question the productivity of the attempts to standardize professional health care through a discussion of the importance of uncertainty. Trisha Greenhalgh's taxonomy of uncertainty is used for an analysis of the clinical reasoning occurring in a life threatening emergency situation with a young patient. The case analysis is further developed by the use of the Canadian philosopher Bernard Lonergan's theory about human understanding and the act of knowing. According to Lonergan it is not by getting rid of or even by reducing uncertainty, but by attending systematically to it and by relating to it in a self-conscious way, that knowledge can be obtained. The analysis demonstrates possible subversive consequences of an increased standardization of health care. The paper concludes that uncertainty is not a regrettable and unavoidable aspect of clinical decision making but a productive component.